In December of 2016 Blue Cross Blue Shield of Massachusetts revised their policy on member benefits for lactation services, expanding coverage for lactation consultation services beyond those conducted in an office setting by a licensed MDs or Nurse Practitioners to include the services provided by licensed lactation consultants or lactation consultants certified by the International Board of Lactation Consultant Examiners, the IBLCE. This policy shift has greatly expanded the options for families seeking help for breastfeeding related challenges. Prior to this shift, only “office visits by licensed providers” qualified as a covered benefit for BCBS of MA, the state’s largest private insurer. This left many families in a bind, as the Commonwealth of Massachusetts doesn’t provide licensing to the allied healthcare professionals collectively referred to as “lactation consultants” and it was the families’ “licensed providers” who were referring patients to the lactation consultants. As a result, many families paid out of pocket, out of desperation, or simply went without needed services. Some of those families paying out of pocket for services provided by IBCLCs then submitted reimbursement, only to have their claims denied. This lead to a maelstrom of disgruntled BCBS families crying foul, citing the Affordable Care Act, which guarantees coverage of “comprehensive prenatal and postnatal lactation support [and] counseling” without cost sharing “for the duration of breastfeeding”.

Draft List of Accepted Lactation Consultation Providers

While BCBS’s policy was intended to conform to the spirit of the ACA, it fell very short in practical coverage benefits for families within the Commonwealth. Following an effort led by the Massachusetts Lactation Consultant Association (MLCA) to educate insurers, including BCBS of MA, of the importance and scope of services provided by trained lactation professionals, BCBS revised the policy this last winter. At a recent meeting of MLCA, it was revealed that a LOT of education was needed to get BCBS up to speed. “They didn’t understand why anyone would need a lactation consultant after leaving the hospital with baby, let alone multiple visits in an outpatient setting.” MLCA also presented BCBS with a draft of a list of private practice and home visit lactation consultants within the Commonwealth, no easy task given that no such directory exists. Names of IBCLCs were drawn from various “Find a Lactation Consultant” type databases, including zipmilk.org, managed by the Massachusetts Breastfeeding Coalition, and ilca.org, managed by the International Lactation Consultant Association, and uslca.org, managed by the United States Lactation Consultant Association. This directory of accepted providers for BCBS of MA members is still in draft form, dynamic, and not published at this time.

LC Services Claims to BCBS Require Tenacity

I made a call to BCBS of MA member services and spoke to a representative named “Madeline” who described the BCBS provider list for lactation services as “an internal list.” She pointed out that office visits by licensed providers, i.e. doctors and NPs, would likely be billed as “in network.” Visits by home visit LCs or small group practices of IBCLCs, such as those provided here at Lactation Care, would like be “covered” but would require payment at the time of service and a reimbursement claim to be submitted by the family. Claim forms for BCBS of MA can be found here: Subscriber Claim Form. Many private practice lactation consultants, including our practice, have been providing families’ with “Superbills”, that essentially function as a claim form, with the added convenience of including the NPI, EIN, and ICD-10 codes on a prefilled form.
While the policy shift at BCBS of MA is a step in the right direction, much remains to be done to clarify the policy, demystify the process of finding qualified lactation care providers, and giving families confidence that claims will not be denied. As of this publish date, one cannot locate on the BCBS of MA website, www.bluecrossma.com, the updated policy or a published list of lactation providers. Worse yet, using “lactation” as a keyword to search for information within the bluecrossma.com site yields a frustrating “0 Results”…

Clearly, BCBS of MA is still playing catch up with work yet to be done to educate their member services team to provide a consistent clear message. Let it be known to those looking for information on the BCBS of MA website that “breastfeeding” as a key word search will provide some information about some lactation related member services. Unfortunately, BCBS members, even lactation professionals, such as myself, continue to be led down many rabbit holes on bluecrossma.com following searches for lactation-related member benefits and providers.

Happily, forces are at work to correct the situation. MLCA representatives continue to be in communication with BCBS to further develop a functional, updatable list of qualified lactation service providers that will hopefully graduate beyond the “internal list” accessible only by phone through member services , 800-262-BLUE (2583), to something readily accessed by the sleep deprived parents of the Commonwealth. Until such a list is published, Massachusetts residents can locate qualified board certified lactation consultants through the searchable databases at zipmilk.org, ilca.org, and uslca.org. Since accreditations lapse, LCs sometimes retire or change practice locations, and new candidates are accredited on a bi-annual basis; families can verify a service provider’s certificate is current and in good standing with the IBLCE here: IBCLC Registry. As “Madeline” at BCBS member services assured me, “if they are IBCLCs in good standing or licensed, the visit will be covered without co-pays or cost sharing.”

Lactation Coverage Will Likely Continue in MA Even If the ACA is Repealed

Happily these benefits are likely here to stay. Even if the ACA were to be repealed or gutted by the current administration, breastfeeding equipment and services are likely to remain as covered benefits for families within the Commonwealth according to Jessica Lang Kosa, PhD, IBCLC. Romney Care predates Obama Care here in Massachusetts and provided the blueprint for the national universal healthcare plan. With over a decade of investment in the infrastructure, Massachusetts is unlikely to throw the baby out with the bathwater. Governor Baker has plans on the drawing board for how to revert back to the 2006 law, should the ACA “explode” as the current presidential administration predicts. Public sentiment in Massachusetts supports universal healthcare and we have the highest rate of insured citizens in the country. Insurers understand that breastfeeding services are, in the overall scheme of things, inexpensive to provide and appealing to the younger adult demographic that is less expensive to insure. Kosa suggests thinking of the breastfeeding member benefits akin to the “gym membership” reimbursement benefit. “It’s a marketing tool that attracts healthy people, the people the insurers want to attract.”

While the future may not be guaranteed, the current state of lactation services in Massachusetts is much improved for families insured by our largest private insurer as BCBS joins other health plans such as Tufts, Harvard Pilgrim Healthcare, Aetna, Neighborhood Health Plan, and Mass Health, among others, that have been providing lactation benefits that predate the ACA.
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About the Author

ANDREA JORGENSEN IBCLC
The newest member of our team, Andrea has been a board certified lactation consultant since 2009 and joined us after several years as a volunteer breastfeeding counsellor and a previous life as a professional chef. A natural Jill-off-all-trades, she wears many hats around the office and enjoys the interdisciplinary aspects of work as an LC. A whiz at coordinating office logistics, she has a knack for managing our office systems and website. With a background in Anthropology and an ear for the unspoken, she particularly enjoys counselling mothers with empathy and humor through the challenging experiences of mothering through breastfeeding in American culture. She helps us all remember to look for the joy and humor in work, life and even in breastfeeding challenges.